The Durable Medical Equipment/Prosthetics and Orthotics (DME/P&O) Consultant functions as the local resource for DME/P&O efforts and initiatives for multiple medical centers under the guidance of Regional management. Develops, implements and tracks initiatives to ensure deliverables are met. Educates and provides support to providers on DME/P&O issues.
Essential Functions:
- Functions as the local resource and provider support on DME/P&O issues including Health Connect training, DME/P&O formulary (clinical and non-clinical) and DME/P&O benefit information.
- Functions as content expert to other colleagues and stakeholders across the region.
- Provides inservice, training and education to local stakeholders and physicians on DME/P&O benefit interpretation, appropriate ordering practices and new products.
- Contributes to Regional training program development and tailors as necessary in deployment.
- Functions as a DME/P&O benefit consultant and attends specialty clinics for high mobility and P&O clinics to provide and explain benefit information.
- Reviews and evaluates vendor quotes for specialized items as necessary.
- Monitors and reports local performance on DME/P&O metrics including UM and Financials.
- Accountable for ensuring deliverables are met.
- Provides guidance to physicians, members and other stakeholders on the DME/P&O benefit coverage and the grievance/denial/appeal process.
- Supports the Assistant Director of DME/P&O with monitoring quality of local vendors and escalates local concerns as needed.
- Works with local leadership to develop and track local action plans to implement DME/P&O initiatives.
- Develops targeted reports as required in support of these initiatives. Identifies opportunities for improvement.
- In conjunction with Assistant Director formulates and develops region wide affordability objectives that have impact throughout the care continuum.
- Formulates specific implementation plans and evaluates the effectiveness of actions/programs implemented.
- Ensures compliance with regulatory requirements.
- Functions include problem resolution, customer follow-up and appropriate escalation to administration as required.
- Builds collaborative relationships with local medical center leadership and providers.
- Coordinates team/project activities and schedules.
- Provides project support per guidance from the Regional DME/P&O management.
Qualifications:
Basic Qualifications:
-Four (4) to five (5) years of general healthcare experience.
- Demonstrated experience working with physicians.
- Experience in improvement process planning, coordinating and implementing projects.
- Bachelor's degree in Business Administration, Public Administration or related field OR equivalent experience.
- Knowledge and understanding of utilization management and DME/P&O Service.
- Excellent communication skills (written and verbal) and computer literacy.
Preferred Qualifications:
- DME experience preferred.
Notes:
- Consultant will travel to areas within Baldwin Park, Downey and South Bay.
- Work schedule will be Monday - Friday, occasional weekends maybe required.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.